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Specialist- Authorization/ منذ أسبوع

Job Description

Core Responsibilities:

  • Facilitate the dental authorization process by reviewing cases in accordance with clinical guidelines.
  • Coordinate with healthcare providers to clarify treatment plans and ensure adherence to policies.
  • Implement authorization decisions based on medical necessity, policy compliance, and cost-effectiveness.
  • Monitor authorization requests for patterns of overutilization or non-compliance.
  • Organize case documentation and maintain accurate records of authorization approvals and denials.
  • Provide clinical insights and recommendations for complex dental cases requiring further evaluation.
  • Draft reports on authorization trends, key metrics, and performance indicators.
  • Liaise with internal and external stakeholders to ensure smooth coordination of dental services.
  • Conduct periodic reviews of provider compliance with dental authorization guidelines.
  • Participate in audits and investigations related to dental claims and pre-authorization processes.
  • Receive and address inquiries from providers regarding authorization decisions.
  • Contribute to continuous improvement initiatives to enhance service quality and efficiency.

Quality & Excellence Management:

  • Assure compliance with Daman’s medical policies, procedures, and regulatory requirements.
  • Monitor key performance indicators related to dental authorization and identify areas for improvement.
  • Participate in quality audits to assess adherence to authorization standards.
  • Implement corrective actions to resolve issues identified through quality assurance reviews.
  • Ensure that all authorization decisions are well-documented and justified based on clinical evidence.

Key Requirements and Qualifications

  • Minimum 3 years in any of the medical units of a health insurance company or third-party administrator (TPA), out of which minimum 1 year as Medical Authorisation Officer
  • Certification in the medical coding systems is a plus
  • Bachelor’s Degree in medicine

Skills and Competencies

  • Good knowledge of health insurance concepts; knowledge of Health Insurance Fraud & Abuse is a plus
  • Good command of written/spoken English; knowledge of Arabic language is an advantage
  • Good analytical, execution, problem solving and decision-making skills
  • Advanced level of customer service orientation and professionalism in all interactions

مشاركة

Daman National Health Insurance Company

Daman National Health Insurance Company

  • سنة التأسيس
    2006
  • الهاتف
    600532626
  • الموقع الإلكتروني
    https://damanhealth.ae/
  • العنوان
    United Arab Emirates
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